Prescription Refill Requests (existing patients only)

If you are a current patient and would like to request a prescription refill please fill out the secure form below. Once you complete the form, click the submit button at the bottom of the form. If you prefer to fax or mail the form, click here.

Please note:

  • Allow a minimum of 2 business days for requests to be processed
  • Our office typically does not contact you to confirm that your prescription has been sent
  • Contact your pharmacy to determine if your prescription is ready before calling our office to check on the status of a request
  • $15.00 fee for prescription refills or replacements done outside of an office visit

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Fax or Mail Instructions

PDF-iconYou may opt to download this form, print it out and complete it. Then you may fax (781) 551-3396, or mail the form.

Questions? Call the main office at 781-551-0999 ext 405.